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DIAGNOSIS
It
is of utmost importance that you understand your diagnosis and what it means.
All of the terms used will be foreign to you and the medical people often will
not have time to explain them all. We list below some of the common terms
you will come across and give you links to find more information on a specific
term. The terms are listed in the sequence in which you might come across
them, as you go through the diagnostic process, from the first visit to your doctor.
COMMON
TERMS
DRE:
This
is the Digital Rectal Examination - much feared by most men, for no good reason
other than embarrassment. Women tell us it is nothing compared to some of their
examinations. Because the prostate gland is so well hidden, the only way it can
be reached is via the rectum. A finger is inserted into the rectum and the doctor
can then feel the gland to see if there are any signs of abnormality.
BPH
[BENIGN PROSTATIC HYPERPLASIA or HYPERTROPHY]
: This is a non-cancerous condition of the prostate gland. It results in the growth
of both glandular and connective tumour-like tissue. This enlarges the prostate
and causes obstruction to the passing of urine. The symptoms are slowing of the
stream, needing to urinate during the night and an urgency to urinate. It is a
benign growth that is present to some degree in all men over 50 years of age.
The PSA may be elevated with BPH and urinary tract infections.
TURP
- Transurethral Resection Of The Prostate:
If BHP (see above description) is serious enough, it can cause the prostate to
restrict the flow of the urine. TURP is usually a minor surgical procedure whereby
an instrument called a resectoscope is inserted into the penis to relieve the
pressure of the prostate on the urethra. There are, however, variations on this
procedure, using heat and laser to achieve the same result.
PSA
- Prostate Specific Antigen: This
refers to the standard test which indicates the possibility of cancer in the prostate.
Very severe cases will have a PSA count in the hundreds, but the threshold of
concern is generally a reading of 4 ng/ml. Some specialists believe a lower figure
to be appropriate. You should be aware of the fact that that your PSA count can
be raised by many things, apart from cancer. In fact only about 35% of men with
an elevated PSA will be found to have prostate cancer. The most common causes
of an elevated PSA reading is are DRE, BPH, bladder or prostate infections and
sexual activities. For more detail on the subject go to PS
101 . Men who have had surgery will often use Ultra-Sensitive
PSA tests, which are also subject to a fair degree of inaccuracy.
BIOPSY:
A biopsy involves taking a small specimen of tissue for microscopic examination.
The prostate is well hidden so it is difficult to take specimens. In the past
six spring-loaded needles were shot into the prostate via the rectum. There is
a move now to use more needles - up to twelve at times. It sounds worse than it
is. For most men it is rather like getting a hard kick in the backside each time
a needle goes in. Other men may have lower pain thresholds and should ask for
some form of pain relief - for some reason this is rarely offered. If you have
had this procedure you will know that urine and semen are usually blood stained
for some time afterwards. There can be other more serious side effects but they
are rarely reported.
PIN
- Prostatic Intraepithelial Neoplasia:
This refers to a pre-cancerous change to the cells of the prostate. It is thoughtby
some experts that that it may 'evolve' into cancer over a period of time - some
reports indicate more than five years. It is important for pathologists to distinguish
between PIN and PCa in their reports.
PCa
- Prostate Cancer
- also frequently referred to as PC. There is little to be said here about the
disease since anyone diagnosed will be focussing on it in all its complexities.
It is important to remember that it is usually a slow growing cancer, except in
very late stages and that there is usually an ample amount of time to research
available options. No one diagnosed with PCa should have to undertake treatment
until they understand what the treatment involves and what the outcomes and side
effects of the treatment will be. As will be seen in the note on Gleason Scores,
the recommendationto is to get a
second opinion on this very important issue from a recognised
expert. One of these experts is Dr Jonathan Oppenheimer who has this to say
on his blog:
For
the vast majority of men with a recent diagnosis of prostate cancer the most important
question is not what treatment is needed, but whether any treatment at all is
required. Active surveillance is the logical choice for most men (and the families
that love them) to make.
GLEASON
SCORES :This
refers to the system of judging the aggressiveness of the tumour. It is one of
the factors by which the likelihood of the cancer spreading beyond the prostate
capsule is judged. A sample of tissue taken from the prostate is examined under
a microscope. Two areas where the cells are not normal are selected [these are
referred to as foci]. Each is graded on a scale of 1 through 5, where 1 is well
differentiated [good] and 5 is poorly differentiated [bad]. The two grades are
added together to give a score on a scale of 2 to 10, where 6 is the mid-point.
The most common scores are 5 and 6. For a more detailed description go here.
The Gleason Score is a critical
item; it drives the decision making process. It is however, a subjective system,
with signficant variances reported and therefore it is important to get a second
opinion from a recognised expert.
STAGING:
This is the system used to describe the extent of the cancer or the degree to
which it has progressed. The old system had four stages - ABCD to describe the
stage of the disease but the currently recommended system is known as the TNM
system. The T refers to the stage of PC within the prostate. The N refers to the
status of the lymph nodes near to the prostate - whether the PC has spread there
or not. The M stage indicates if there are any mets. The result is a formula such
as T2aN0MX. This would indicate a stage 2 (a) cancer in the prostate with no sign
of spread to the lymph nodes and an inability to ascertain the presence or absence
of any mets.
The
initial staging is known as the clinical stage and is signfied by the letter c
in front of the formula mentioned above - the most common staging being cT1cN0M0.
If the gland is removed in surgery, another pathology report is prepare. The pathological
staging is usually different to the clinical staging and is prefixed by the letter
p for example pT2cN0M0. For a more detailed description go here.
METS:
Metastases. These are the cancer sites away from the prostate and are sometimes
referred to as secondaries. As PC grows within the prostate it starts to spread
throughout the body and becomes much more difficult to control. This is the rationale
for early diagnosis - to catch the PC before it metastasises.
PARTIN
TABLES
: These tables are used to try and calculate the likelihood of the spread of PC
out of the capsule of the prostate using your PSA, Gleason Ratings and Staging.
Although they look complicated at first, they are understandable with a bit of
patience. As part of your understanding of your condition you should do your best
to do this. This page prepared
by the Brady Urological Institute gives a very good explanation and allows you
to make your own calculation of the probablities. to do this you will need your
staging, your PSA and your Gleason score.
BONE
SCAN
: This test is to establish whether there are any mets to the bones - in other
words if the cancer has escaped from the prostate capsule and spread to the bones.
It is generally considered unlikely that there will have been a spread if the
PSA reading is under 10 - some feel that this applies to readings under 20.
MRI - Magnetic Resonance Imaging : A comparatively new method
of scanning the prostate to detect any signs of PC.There is a good explanation
of what this test does and how it works at
RadiologyInfo.
ADENOCARCINOMA
: The word generally used to describe epithelial tissue in a gland that has become
malignant. It is identified in a pathology laboratory and given the name of the
tissue affected. eg the prostate gland tumour gets the name 'prostate adenocarcinoma',
because its cells resemble the cells of the prostate. There are many sites on
the topic, but are narrowed by only dicussing the action of particular treatment
options, eg, radiation therapy or hormone therapy.
We
have only listed some of the most common terms. There are many comprehensive Glossaries
on the internet giving many more of the terms used. We give below two links to
Glossaries.
